ebook img

Reality Therapy: A New Approach to Psychiatry PDF

184 Pages·2010·0.84 MB·English
Save to my drive
Quick download
Download
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview Reality Therapy: A New Approach to Psychiatry

REALITY THERAPY A NEW APPROACH TO PSYCHIATRY by WILLIAM GLASSER M.D. With a Foreword by O. H. MOWRER, Ph. D. To G. L. Harrington, M.D. Contents Foreword Note to the Paperback Edition Part I THEORY Introduction 1. Basic Concepts of Reality Therapy 2. The Differences between Reality Therapy and Conventional Therapy Part II PRACTICE Introduction 3. The Treatment of Seriously Delinquent Adolescent Girls 4. Hospital Treatment of Psychotic Patients 5. The Office Practice of Reality Therapy 6. The Application of Reality Therapy to the Public Schools—Mental Hygiene Acknowledgments ABOUT THE AUTHOR Books by William Glasser Copyright About the Publisher Notes Foreword This is an extraordinarily significant book. Readers will themselves discover that it is courageous, unconventional, and challenging. And future developments will, I predict, show that it is also scientifically and humanly sound. For more than a decade now, it has been evident that something is seriously amiss in contemporary psychiatry and clinical psychology. Under the sway of Freudian psychoanalysis, these disciplines have not validated themselves either diagnostically or therapeutically. Their practitioners, as persons, have not manifested any exceptional grasp on the virtues and strengths they purportedly help others to acquire. And the impact of their philosophy of life and conception of man in society as a whole has been subtly subversive. Because they were the main “losers,” laymen were the first to become vocal in their discontent, distrust, and cynicism. But today there is a “shaking of the foundations” in professional circles as well. For example, a state hospital superintendent recently said to me: “Yes, we too think we have a good hospital here. At least we aren’t doing the patients any harm. And that’s progress. In the past, we psychiatrists have often spread the disease we were supposedly treating.” Late in his training as a psychiatric resident, Dr. Glasser saw the futility of classical psychoanalytic procedures and began to experiment with a very different therapeutic approach, which he eventually named Reality Therapy. Rather than a mere modification or variant of Freudian analysis, this system is in many ways absolutely antithetical. At the outset of Chapter 2, six postulates are listed as characterizing most forms of professional psychotherapy now practiced in the United States and Canada, ranging from “simple counseling through nondirective therapy to orthodox psychoanalysis.” These six postulates or presuppositions are: the reality of mental illness, reconstructive exploration of the patient’s past, transference, an “unconscious” which must be plumbed, interpretation rather than evaluation of behavior, and change through insight and permissiveness. The extent of Dr. Glasser’s break with this total tradition is indicated by the following simple but bold statement: “Reality Therapy, in both theory and practice, challenges the validity of each of these basic beliefs.” Moreover, Dr. Glasser states that the “conventional therapist is taught to remain as impersonal and objective as possible and not to become involved with the patient as a separate and important person” in a patient’s life. In Reality Therapy, the helping person becomes both involved with and very real to the patient in a way which would be regarded as utterly destructive of the transference as conceived and cultivated in classical analysis. More concretely and positively, what then is Reality Therapy? Chapter 1 answers this question, in concise and nontechnical language; and Chapters 3 to 6 exemplify the approach as it has been applied in various contexts. In essence, it depends upon what might be called a psychiatric version of the three R’s, namely, reality, responsibility, and right-and-wrong. Dr. Glasser begins at the end of this formula and asks, early in Chapter 1: “What is wrong with those who need psychiatric treatment?” The answer is that they have not been satisfying their needs. Here it might appear that Reality Therapy and psychoanalysis have something in common, but not so. For Freud, the needs which are presumably unfulfilled, in the so-called neurotic, are those of sex and aggression. For Glasser the basic human needs are for relatedness and respect. And how does one satisfy these needs? By doing what is realistic, responsible, right. Granted that it is not always clear precisely what is right and what is wrong, Dr. Glasser nevertheless holds that the ethical issue cannot be ignored. He says: To be worthwhile we must maintain a satisfactory standard of behavior. To do so we must learn to correct ourselves when we do wrong and to credit ourselves when we do right. If we do not evaluate our own behavior or, having evaluated it, if we do not act to improve our conduct where it is below our standards, we will not fulfill our needs to be worthwhile and will suffer as acutely as when we fail to love or be loved. Morals, standards, values, or right and wrong behavior are all intimately related to the fulfillment of our needs for self-worth and [are] … a necessary part of Reality Therapy. Conventional psychiatry and clinical psychology assume that neurosis arises because the afflicted individual’s moral standards are unrealistically high, that he has not been “bad” but too good, and that the therapeutic task is, specifically, to counteract and neutralize conscience, “soften” the demands of a presumably too severe superego, and thus free the person from inhibitions and “blocks” which stand in the way of normal gratification of his “instincts.” The purview of Reality Therapy is, again, very different, namely, that human beings get into emotional binds, not because their standards are too high, but because their performance has been, and is, too low. As Walter Huston Clark has neatly put it, the objective of this (radically non-Freudian) type of therapy is not to lower the aim, but to increase the accomplishment. Freud held that psychological disorders arise when there has been a “cultural” interference with the instinctual, biological needs of the individual, whereas Glasser and others are now holding that the problem is rather an incapacity or failure at the interpersonal, social level of human functioning. This categorical reversal of both the theory of neurosis and the intent of psychotherapy has far-flung implications. Freudian therapists and theorists concede, of course, that not everyone suffers from over-development of the superego. At least certain kinds of delinquents and criminals, they admit, have too little rather than too much conscience; and in the case of the very young and inexperienced, their problem is similarly a deficit of character rather than a presumed excess. Thus, in the psychoanalytic frame of reference, two types of “therapy” are called for, the one essentially educative, the other re-educative or “corrective” in the sense of undoing the effects of past efforts at socialization which have presumably been “too successful.” Dr. Glasser’s view of the matter is quite different. He assumes that so-called neurotic and psychotic persons also suffer (although not so severely as do delinquents and frank sociopaths) from character and conduct deficiencies; and if this be the case, then all therapy is in one direction, that is, toward greater maturity, conscientiousness, responsibility. Glasser says: Using Reality Therapy, there is no essential difference in the treatment of various psychiatric problems. As will be explained in later chapters, the treatment of psychotic veterans is almost exactly the same as the treatment of delinquent adolescent girls. The particular manifestation of irresponsibility (the diagnosis) has little relationship to the treatment. From our standpoint, all that needs to be diagnosed, no matter with what behavior he expresses it, is whether the patient is suffering from irresponsibility or from an organic illness. Not only does this author assume that all “psychiatric problems” are alike; he also regards their treatment as of a piece with the educational enterprise in general. Thus in Chapter 6 it turns out that Reality Therapy is congenial to and readily applicable by classroom teachers in conjunction with their regular pedagogical activities (rather than contradictory to them); and it is also apparent that here is an approach to “child rearing” and “mental hygiene” which is for parents rather than against them. In a recent issue of The Saturday Evening Post, a housewife and mother complains bitterly (but justifiably) that psychiatrists have produced a “generation of parent-hating children.” It could hardly have been otherwise, for the basic premise of psychoanalytic theory is that neurosis arises from too much training of children by their parents (and other teachers), so that this condition is patently the latter’s “fault.” Far from helping children to become more mature and accountable, this philosophy has steered young people toward ever deeper delinquency, defiance, and rejection of parents and authority. Thus Reality Therapy is not something which should be the exclusive preoccupation or “property” of a few highly trained (and expensive) specialists. It is the appropriate, indeed the necessary, concern of everyone, for its precepts and principles are the foundation of successful, satisfying social life everywhere. Although Freudian psychoanalysts have been arch-critics of our mores, morals, and values, it is doubtful that they could themselves design and direct a viable society, for the very conventions and moral standards which analysts so freely criticize are precisely what keep groups and persons from “falling apart.” As Professor C. Wright Mills (the sociologist) and Dr. Richard R. Parlour (a forensic psychiatrist) have recently pointed out, ethical neutrality and anomia cannot provide the structure of organization and power and the context of personal identity and meaning which are as essential to individuals as they are to groups. The work of the psychologist, Dr. Perry London, and of anthropologist Jules Henry adds further weight to this opinion. Now we come to the second of the three R’s, responsibility. What is it? Glasser says: Responsibility, a concept basic to Reality Therapy, is defined as the ability to fulfill one’s needs, and to do so in a way that does not deprive others of the ability to fulfill their needs. … A responsible person also does that which gives him a feeling of self-worth and a feeling that he is worthwhile to others. He is motivated to strive and perhaps endure privation to attain self-worth. When a responsible man says that he will perform a job for us, he will try to accomplish what was asked, both for us and so that he may gain a measure of self-worth for himself. An irresponsible person may or may not do what he says, depending upon how he feels, the effort he has to make, and what is in it for him. He gains neither our respect nor his own, and in time he will suffer or cause others to surfer. In a recent article, Dr. Glasser has expressed the same general point of view by saying: “People do not act irresponsibly because they are ‘ill’; they are ‘ill’ because they act irresponsibly.” This is an emphasis which has been almost totally absent in classical psychoanalysis. For Freud and his many followers, the neurotic’s problem is not irresponsibility but lack of “insight.” However, many clinicians have discovered that years of analytic questing for this objective often results in less concrete change in a patient’s life than a few weeks of work on the problem of personal responsibility, consistency, accountability. (This is confirmed in the writings of Dr. Steve Pratt on the concept of social contract and its relation to what Professor Leonard Cottrell has termed “interpersonal competence.”) In other words, it’s not “insight,” “understanding,” and “freedom” that the neurotic needs but commitment. In the words of an old hymn, our petition can appropriately be: Holy Spirit, Right Divine, Truth within my conscience reign, Be my King that I may be, firmly bound, forever free. In keeping with this way of thinking about responsibility, what is to be said about honesty, truthfulness, and integrity? As long as one assumes that the neurotic is typically over-trained in moral matters and that his condition is not in any way dependent upon decisions he himself has made and actions he has taken but is rather an expression of things that have been done to him, then the very possibility that dishonesty enters into the picture in any very significant way is excluded, both logically and practically. But when the so-called “sick” person is himself seen as accountable for much of his malaise, dishonesty begins to figure much more prominently. In this book there is not a great deal of explicit emphasis on getting persons who are undergoing therapy to speak the truth; but the therapist himself sets an example of personal openness and integrity, and it is hard to imagine that anyone can learn to be either responsible or realistic without also being truthful. In fact, anyone who makes a practice of misinforming others (and thus being irresponsible), eventually begins to lie to himself, in the sense of rationalizing and excusing his own deviant behavior; and when this happens, he begins to be unrealistic, to “lose contact” with reality. In light of the widespread and growing interest today in group therapy, it may appear to some readers of this book that Dr. Glasser is still too much wedded to individual treatment. Such an impression is misleading. Most of the work at the Ventura School for Girls which is here described involves group methods, as does the work of Dr. G. L. Harrington at the Los Angeles Veterans’ Administration Hospital and that of Dr. Willard A. Mainord at the Western State Hospital, in Washington, which are also prominently featured in this book. One of the great advantages of the group approach is that it encourages the development of rectitude, responsibility, and realism so much more rapidly than do the conventional forms of individual treatment. Now what is realism, reality? Although this concept is crucial to Dr. Glasser’s approach, in some ways it is the most difficult of all to pin down specifically. Two statements which bear directly on this problem follow: In their unsuccessful effort to fulfill their needs, no matter what behavior they choose, all patients have a common characteristic: They all deny the reality of the world around them. Some break the law, denying the rules of society; some claim their neighbors are plotting against them, denying the improbability of such behavior. Some are afraid of crowded places, close quarters, airplanes, or elevators, yet they freely admit the irrationality of their fears. Millions drink to blot out the inadequacy they feel but that need not exist if they could learn to be different; and far too many people choose suicide rather than face the reality that they could solve their problems by more responsible behavior. Whether it is a partial denial or the total blotting out of all reality of the chronic back-ward patient in the state hospital, the denial of some or all of reality is common to all patients. Therapy will be successful when they are able to give up denying the world and to recognize that reality not only exists but that they must fulfill their needs within its framework. … The therapist who accepts excuses, ignores reality, or allows the patient to blame his present unhappiness on a parent or on an emotional disturbance can usually make his patient feel good temporarily at the price of evading responsibility. He is only giving the patient “psychiatric kicks,” which are no different from the brief kicks he may have obtained from alcohol, pills, or sympathetic friends before consulting the psychiatrist. When they fade, as they soon must, the patient with good reason becomes disillusioned with psychiatry. Although implied by and embedded in Reality Therapy as a whole, there is a way of thinking about the question of what is and what is not “realistic” which can and perhaps should be made more explicit. From one point of view, it can be argued that all experience is reality of a kind. Phenomenologically, there is certainly nothing unreal about illicit or perverse sexual behavior, criminal activities, or the total life style of persons we call neurotic or even psychotic. Literally everything that happens is reality. Therefore, some special principle or dimension is needed to make the distinction between reality and irreality fully meaningful. In short-run perspective, there is something “realistic” and “good”—in the sense of pleasurable—about all perverse, criminal, or defensive

Description:
Glasser's classic bestseller, with more than 500,000 copies sold, examines his alternative to Freudian psychoanalytic procedures, explains the procedure, contrasts it to conventional treatment, and describes different individual cases in which it was successful.
See more

The list of books you might like

Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.